The Clubfoot: The Present and a View of the Future is a monumental source book of far greater magnitude and scope than has previously been written on this subject. It disseminates recent advances in basic and clinical research on the clubfoot. The introduction places the progress of the last 20 years in perspective. Papers present and evaluate the latest surgical techniques and the management of newly understood complications. The editorial comment section at the end of each chapter offers comparative analysis of the topics discussed in that chapter. This volume is a superb tool for pediatric orthopedists and orthopedists specializing in foot and ankle surgery who want to advance their knowledge of research, clinical management, and operative techniques in patients with clubfeet.

This book is the result of an international symposium on bone transplantation, the first of its kind, held in Berne, Switzerland, on May 14-16, 1987. This symposium brought together some of the most outstanding experts - from all over the world, principally from North America and Europe -in the clinical bone transplantation and in basic research. It was an unique opportunity to summarize in a few days the state of the art in this field and to bring clinicians who carry out some research related to their work together with basic scientists. The clinician can on the one hand profit from the basis researcher's knowledge and on the other stimulate the researcher to share the orthopedic surgeon's interest in osteo articular allografts. The book, like the symposium, contains two types of contributions: 1. Papers from invited experts who have often dedicated a significant part of their professional life to the subject of bone transplantation. Knowledge which would otherwise be scattered among original papers from many different sources, some of it less firmly established and therefore less well known, is thus collected together in one volume, so that the reader does not have to weed out a mass ofless important material. These chapters may for a certain time act as a textbook on bone transplantation, but inevitably will eventually be superseded by new findings. 2. Descriptions of current research in all the main subjects covered in the state of-the-art papers."

Recent experience of the treatment of segmental idiopathic necrosis of the femoral head are discussed in this book by several experts. The discussed methods oftreatment are practically unknown in the US orthopaedic literature. It describes alternate methods of treatment with regard to total joint replacement In Chapter 1 Dr. Wagenhauser expresses his thoughts on posture and its affects on the human body. The following 7 chapters focus on diagnosis and treatment of idio pathic necrosis of the femoral head - an especially timely subject since the incidence of this disease, which primarily affects males during the most active period of their lives, seems to be increasing. New Haven, Connecticut, August 1981 Ulrich H. Well The Question of Posture F. J. Wagenhliuser Every expert would agree with Taillard (1964) that. posture is the most unsettled of all orthopaedic problems. Its onus of ambiguity no longer concerns orthopaedists alone, nor is it limited only to the fields of medical practice and research. It is, rather, a fundamental question spanning a wide range of sciences and occupations that deal with human exist ence and actions. Therefore fascination with this problem has steadily increased. Ques tions on human posture, its concepts and terminology, its normal forms and variations, the diagnosis of pathologic disorders, and their response to treatment concern many of today's anatomists, pathologists, physiologists, orthopaedists, rheumatologists, pediatri cians, gerontologists, psychiatrists, psychosomatic therapists, physiologists, behavioral therapists, and epidemiologists."

Skeletal involvement is a frequent and troublesome complication affecting many patients with neoplastic disease, especially multiple myeloma and cancer of the breast, lung, and prostate. This involve- ment can finally lead to local bone destruction with resulting frac- tures, local bone neoformation, or hypercalcemia. The latter com- plicates the clinical course of 10%-20% of the patients with non-smaIl-cell lung cancer and mammary tumors. Both knowledge of the pathophysiologic mechanisms and treatment of this skeletal involvement have progressed substantially in the last years. One of the very recent therapeutic advances has been the finding that bis- phosphonates, a family of compounds characterized by a P-C-P bond, are effective in alleviating some of these conditions. This volume represents the proceedings of a workshop held on December 4, 1987, in Lucerne, Switzerland, devoted to the use of bisphosphonates in tumoral bone disease. This educational work- shop was organized by the Swiss Group for Clinical Cancer Research (SAKK) to foster international scientific exchange and to clarify experimental and clinical problems in the therapeutic appli- cation of bisphosphonates. Experts from various countries were invited to present and discuss their experimental findings and their preliminary clinical results. This volume summarizes the invited contributions, which will be of major interest to clinical oncolo- gists, surgeons, internists, endocrinologists, and pathologists con- fronted with bone destruction in neoplastic disease. We acknowl- edge gratefully the support of Boehringer Mannheim (Schweiz) AG, Rotkreuz.

Many different opinions exist as to the appropriate diagnostic workup and therapy for spinal tumors. With the advent of new imaging techniques and therapeutic regimens, an up-to-date reference work has become an urgent requirement. This book is designed to meet this need, and is the first of its kind to offer an overview of the opinions of internationally renowned specialists in the field. By addressing in detail all of the relevant topics and areas of contention, it should prove of great value in establishing rational imaging and therapeutic protocols for spinal tumors.

For a long time I have felt that the present gynaecological training for registrars lacked familiarisation and understanding of the basic principles of surgery. This is due to several factors. Firstly, the historical separation of gynaecology from general surgery which led to our development as an independent speciality (and which Victor Bonney foretold to our detriment when he opposed the formation of the College of Obstetricians and Gynaecologists as a separate body from the College of Surgeons). Secondly, a vast improvement in medical management of many gynaecological conditions has made surgical practice dull and an unquestioning daily routine with little or no surgical instruction for many junior staff. Thirdly, the arrival of subspecialisation has exacerbated this, as complicated surgery may be referred out by the general gynaecologist. Finally, the trend in further education towards writing an MD rather than taking an FRCS degree. The arguments for and against were set out in an editorial in the British Journal of Obstetrics and Gynaecology (1983), later taken to task in the ensuing correspondence. That editorial. together with the difficulty in finding up-to-date articles on surgical principles in one volume, were the catalysts for this book. With the help of colleagues from other disciplines, I have attempted to present recent advances side-by-side with modern-day gynaecological practice.

Percutaneous lumbar discectomy is a new surgical method for treating lumbar disc diseases. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the nucleus pulposus under local anesthesia. Probably 20 % of all patients requiring lumbar disc surgery can be successfully treated by this method. During the past two years, percutaneous discectomy has spread rapidly, and it is now performed in most clinical departments engaged in spinal surgery. The first International Symposium on Percutaneous Lumbar Discectomy, held in Berlin in August 1988, covered all current procedures known as "percutaneous discectomy" and the entire range of percutaneous techniques, both clinical and experimental. Its publication is important because of the recency of this new surgical procedure, the outstanding experience of the speakers - including the Japanese, American, and European "pioneers" of the technique - and last but not least the gaps in the knowledge of physicians concerning this topic. This procedure opens up new perspectives in the surgical treatment of degenerative diseases of the lumbar spine.

The introduction of the operating microscope as a surgical tool revolutionized the treatment of peripheral nerve lesions. A new era thus began in the early 1960s, which led to a substantial improvement in the management of nerve lesions. The results of nerve grafting techniques have demonstrated that, independent of the length of the defect, lesions can be successfully bridged. The free tissue transplants with microvascular anastomosis have also opened new, rewarding possibilities for peripheral nerve reconstruction procedures, facilitating the achievement not only of satisfactory anatomical but also of satisfactory fUhctional results. In order to evaluate the state of the art and reflect retrospectively on 25 years of microneurosurgical treatment of peripheral nerves, numerous outstanding scientists and clinicosurgical physicians were invited to Hanover in order to exchange their viewpoints and experiences. An active und fruitful discussion resulted which dealt with the many aspects of anatomy, pathology, clinical and neuro physiology, diagnosis, and with the surgery and physiotherapy which constitute modern-day peripheral nerve lesion treatment. The excit ing ongoing experimental and clinical activities have led us to support the wish and idea to publish the scientific exchange which took place during the Hanover symposium. I truly believe that the articles presented in this book cover so many interesting subjects concerned with peripheral nerve lesions that the book will serve the interested and dedicated physician involved with such cases as a reference work for the basics and also provide him with the therapeutic guidelines to assist him in his daily work."

As one of the leading specialists in hip arthroscopies, Dr. Joseph McCarthy's proposed text Early Hip Disorders promises to become a definitive addition to the field. Featuring full color, arthroscopic views and contributions from such prestigious figures in the orthopaedic community as John McGinty, Richard Villar and James Bono, this text will cover all the essentials of hip arthroscopy including: examiniations, arthroscopic procedures for loose bodies, labral injuries, defects of the femoral head and acetabulum, treatment for infections, tumors, differential diagnosis and, most uniquely, a section on pediatric hip injuries. In addition, this text will provide the surgeon with detailed analysis of cost considerations and comparison with open hip procedures as well as outcome analysis. This text is a must- have for any orthopaedic surgeon interested in learning the newest procedures in the treatment of hip injuries and providing their patients with the safest, most effective treatment available.

It is with great pleasure and, much interest that I accepted to write the foreword to this book by Paul Doury, Yves Dirheimer, and Serge Pattin on the subject of "algodystrophy." First, because I know the extent of their personal experience, from which they have selected the best for this book. Second, because it seemed to me that their detailed analysis of the numerous works on the subject, works which have been published all over the world and which provide diverse physiopathologic interpretations, would provide a comprehensive study meeting a real need. Algodystrophy, to adopt the term used by the authors, merits rheumatolog ists' careful attention. It is indeed a frequent condition and, as is now well known, occurs in the most varied etiologic circumstances; it is not solely posttraumatic, a notion on which diagnosis had long been based. This variable etiology suggests the complexity of algodystrophy's pathogenic mechanism."

Since 1958 the Association for the Study of Internal Fixation (ASIF) has worked to establish the experimental and biomechanical prin ciples of the operative treatment of fractures. It has been proven that immediate, pain-free mobilization, made possible by stable internal fixation, is the key to restoring function in a fractured extremity. The same principles were applied in 1972173 by Roland Schmoker, who developed a universal plate and sophisticated instrument set designed initially for the treatment of comminuted fractures of the mandible. To extend the applications of his plate to reconstructions after ex tensive tumor resections, he supplemented the device with tem poromandibular joint prostheses and anchoring elements for the at tachment of dentures. He first tested the functional stability of these implants experimentally in sheep. Later he found that the minipig had a more human-like jaw shape and masticatory action, and so he tested the implants in 37 mini pigs that underwent extensive mandibular re sections without bone grafting, using sequential dye injections and postoperative weight gain to chart the progress of osseous regener ation. Seven other animals were not operated and served as controls."

Sonography is a noninvasive diagnostic method that has gained an established place in many branches of medicine. Although the inability of ultrasound to penetrate bone delayed its application in the orthopedic field, the successful work of R. Graf in the early detection of pediatric hip disorders with ultra sound has served as an impetus for the increasing use of sonogra phy to detect and evaluate abnormalities of the musculoskeletal system. It is certain that further advances in this modality will be forth coming, and that sonography will be applied to new lines of inves tigation in orthopedic diagnosis. In Arthrosonography the authors use concise text and copious illustrations to demonstrate the potential applications of articular ultrasound, its diagnostic capabilities, and technical aspects of the ultrasound examination. Potential pitfalls are also explained. This book is the logical outcome of the application of diagnos tic ultrasound in orthopedics and rheumatology. It covers all basic practical aspects of arthrosonography and will be a valued re source for those concerned with the evaluation of the musculo skeletal system. HANS RETTIG Contents Introduction . . . . . . . . . . . . . 1 The Piezoelectric Effect - The Basis of Modem Sonography . . . . . . 1 Ultrasound Techniques. . . . . . . . . . . 1 General Principles of Diagnostic Ultrasound 2 Landmarks for Arthrosonography 6 Artifacts ........ . 6 Reverberations . . . . . 7 Hyperbolic Artifacts . . 7 Acoustic Mirror Image . 8 Special Phenomena in Arthrosonography 8 "Wandering Echo" Phenomenon . ."

The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice, nor to the clinical and scientific problems that still need solving in this area. Several factors stand in the way of progress in this field, such as the strongly subjective nature of the complaints, the frequent lack of correlation between them and objective findings, and the complexity of the psychosomatic interac tions involved. Although progress in our knowledge has been much slower than we would have wished, and although we are well aware of these many gaps, it was considered useful to gather in a book what we think we have learned during 3 decades of active interest in pain patients and pain problems in gynecologic practice and 12 years of supervision of a pain clinic in the Department of Obstetrics and Gynecology of Leuven University. As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic practice. When presented with a complaint of lower abdominal and/or low back pain, the gynecologist should constantly be on the lookout for nongynecologic causes, of which the most frequent will be either gastroenterologic or orthopedic and sometimes urologic. I have been fortunate in obtaining the collaboration of Dr."

Inherited skeletal disorders have a fascination for many medical and surgical disciplines. For the geneticist there is interest in the study of families and their inheritance of lesions. The paediatrician is concerned because most of the disorders present in childhood as a problem in clinical differential diagnosis. The radiologist is interested because of the manifest, multiple and curious bone changes that provide a challenge in diagnosis and classification. The orthopaedic surgeon is involved because they present a challenge in the management of the many and various lesions of the limbs and trunk. Most of the text books are slanted towards one or other aspect of the subject, depending upon the specialist interests of their author. Though informative to colleagues in their own discipline, the information which they contain is liable to be overwhelming in its complexity or unhelpful in its content for the orthopaedic surgeon or trainee. Frank Horan and Peter Beighton have aimed their admirable and concise monograph to help the orthopaedic surgeon-the one individual who is likely to be able to ameliorate the musculo-skeletal problems from which so many of the children and adults with these diseases suffer. In recent years, much more orthopaedic help has become available for dysplastics.

Commissioned by the Swiss Federation of Manual Medicine and under the patronage of FIMM (International Federation of Manual Medicine) we conducted an international seminar during the week following the 7th Inter national Congress of FIMM (Zuerich/Switzerland - September 1983). Thirty Manual Medicine experts had come together in the education center of the Cloister Fischingen secluded in the eastern part of Switzerland and away from any city life, to discuss in a week long seminar the status of Man ual Medicine. Working together in the form of several groups, the following points were emphasized: - terminology - diagnostic criteria (are Manual Medicine findings reproducible?) - therapeutic interventions (degree of congruity of treatment plans) The participants demonstrated great enthusiasm and commitment, and so it was possible to have the content of the individual group's discussion com municated to and presented for further scrutiny to all participants during the seminar week. As members of the organizing committee and as the editors of this publica tion, we hope to help establish a more standardized international terminolo gy concerning the field of Manual Medicine. As this clinical trial (investigating the diagnostic reliability and the therapeu tic efficiency of MM) shows, factors such as terminology, diagnostic criteria and therapeutic plans are a prerequisite for multi-center studies.

The reconstructive surgery of posttraumatic deformities has made significant advances in recent years. Reports on technical progress and clinical results are encouraging, even though they have often raised patient expectations to an unrealistic level. The operative methods available to us today enable corrective osteotomies to be performed with a high degree of accuracy and success. Precisely because the sequelae of trauma are so difficult to schematize, every case must be evaluated individually based on a critical assessment of subjective complaints, diagnosis and prognosis before a decision can be made. The planning and execution of corrective procedures are carried out with the same meticulous care as for idiopathic limb deformities. However, the occurrence of a traumatizing event with its immediate and long-term complications calls for special insight in the setting of therapeutic goals. It is essential that the patient be appraised of the results that can reasonably be expected and of the risks that are involved. Success in therapeutic procedures requires detailed theoretical knowledge, thorough operative training, and a strong commitment on the part of the surgeon. It is these aspects of the corrective surgery of posttraumatic deformities with which the editors are principally concerned.

During recent decades there has been a revolutionary change in the life expectancy and quality of life of the hemophiliac. This has been achieved by hematologic and c1inical research, and the future for the hemophiliac depends upon further medical knowledge and research. In spite of the dramatically improved life situation of hemophiliacs, hemorrhagic complications remain a threat. The hemorrhagic disorder may influence and/or aggravate the course of trauma or other diseases in these patients. Hemophiliacs suffering from hemorrhagic complications or eligible for elective surgery should be referred to Hemophilia Treatment and Training Centers, where evaluation and examination are performed by a multidisciplinary team with experience and interest in the disease. The radio10gist is an important member ofthis team. In the past diagnostic imaging has been based mainly on conventional radiography, and this is still very important for the diagnosis ofhemophilic complications, but the diagnostic imaging of today offers a wide range of modalities-conventional radiography, computed tomography, sonography, radionuc1ide imaging, and, in its infancy, magnetic resonance imaging. Thus there is a need for a thorough description of the potential and limitations ofthese modern diagnostic techniques.

The first edition of Surgery of the Hip loint has had certain measures of success. Its cover won the Outstanding Award for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authorita tive reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students."

The current interest in developing novel materials has motivated an increasing need for biological and medical studies in a variety of dinical applications. Indeed, it is dear that to achieve the requisite mechanical, chemical and biomedical properties, especially for new bioactive materials, it is necessary to develop novel synthesis routes. The tremendous success of materials science in developing new biomaterials and fostering technological innovation arises from its focus on interdisciplinary research and collaboration between materials and medical sciences. Materials scientists seek to relate one natural phenomenon to the basic structures of the materials and to recognize the causes and effects of the phenomena. In this way, they have developed explanations for the changing of the properties, the reactions of the materials to the environment, the interface behaviors between the artificial materials and human tissue, the time effects on the materials, and many other natural occurrences. By the same means, medical scientists have also studied the biological and medical effects of these materials, and generated the knowledge needed to produce useful medical devices. The concept of biomaterials is one of the most important ideas ever generated by the application of materials science to the medical field. In traditional materials research, interest focuses primarilyon the synthesis , structure, and mechanical properties of materials commonly used for structural purposes in industry, for instance in mechanical parts of machinery.

Arthroscopic Laser Surgery: Clinical Applications is designed to introduce the use of lasers to the orthopaedic surgeon who performs arthroscopic surgery and is the first text of its kind entirely devoted to the unification of these two exciting technologies.
This groundbreaking work examines the following subjects: - the basic sciences of laser arthroscopy as well as the history of its development - techniques for arthroscopic laser applications in the knee, for carpal tunnel release, ankle, shoulder, and much more - practical, clinical guidelines on its advantages, disadvantages, and complications - technical overview of the laser systems currently in use in the United States and worldwide - important safety measures and administrative issues - glossary of terms and reference sources.
Each chapter is written by an arthroscopic laser surgeon distinguished in both his knowledge of the topic addressed as well as by his expertise with that specific laser arthroscopic system. Over 120 full-color illustrations enhance the presentation. The definitive text of arthroscopic laser surgery applications and technique, this volume is a must-have information source for all orthopaedic surgeons.

Since the first edition of this book, sonography of the peripheral nervous system has evolved further. This second, revised edition includes many state-of-the-art high-resolution images, the text has been adapted to reflect the current state of the literature, and information is presented using a more modern layout. This book provides a practical, clinically oriented overview of all aspects of sonographic diagnosis and interventional therapy of the peripheral nervous system.

Interest in bone densitometry methods has recently experienced a resurgence within the medical community. Physicians have become more interested than ever before in the diagnosis and treatment of degenerative diseases of bone such as osteoporosis. The public perception of osteoporosis and its prevention has been recently heightened. Because osteoporosis is widespread, especially in women, and leads to an increase in fractures in our population, many re searchers and clinicians are strongly motivated in their search for more sensi tive and accurate methods of diagnosis. This book was written for physicians, scientists, engineers, medical phy sicists, and others desiring an introduction or further understanding of this exciting field. Beginning with the early development of x-ray film methods for assessing bone status, the field has steadily grown throughout the years. Novel and interesting devices have been designed for the measurement of bone mass, bone density, cortical thickness, and other parameters of bone changes. Both qualitative and quantitative bone methods are described. The techniques include imaging devices such as CT and radiography as well as fixed point methods in which bone characteristics of a region of interest are analyzed."

Why anDther series .on infectiDus disease? The questiDn is a fair .one in view .of the proliferatiDn .of mDnDgraphs, texts, and periDdicals .on the vast subject .of infectiDus disease. The gDal .of this series is tD provide an additiDnal service tD the clinician in the fDrm .of clinical infDrmatiDn nDt usually assembled in .one convenient vDlume. One type .of mDnDgraph presented in this series will CDver a specific infecti.on, detailing microbi.ol.ogic research and clinical aspects. It is h.oped that such a cDmpilati.on will be helpful in bDth its thDroughness and breadth tD the clinician interested in this particular problem. The .other type .of mDnDgraph that this series will pr.ovide will discuss a clinical presentati.on that c.omprises many pDssible specific etiDI.ogies. V.olumes in the series will be multiauthDred, giving us the DppDrtunity tD invite auth.orities in each specific area t.o cDntribute their expertise and experience. Regular revisions are planned SD that each v.olume will remain as current as it is thorDugh. We hDpe that .our gDals are met and that the present series .of mDn.o graphs establishes its .own identifiable and valuable niche in the growing cDmpendium .of resDurce material available tD the clinician. Contents Series Preface ....................................................... VB Contributors .......................................................... Xl Introduction ......................................................... xv 1. Acute Osteomyelitis FRANCIS A. WALDVOGEL ...................................... ."

Biomechanics is concerned with the response of living matter to forces, and its study has taken long strides in recent years. In the past two decades, biomechanics has brought improved understanding of normal and patho physiology of organisms at molecular, cellular, and organ levels; it has helped developing medical diagnostic and treatment procedures; it has guided the design and manufacturing of prosthesis and instruments; it has suggested the means for improving human performance in the workplace, sports, and space; it has made us understand trauma in war and in peace. Looking toward the future, we see many more areas of possible development such as: reduction in heart diseases and atherosclerosis improved vascular assist and replacement devices, including a permanent artifical heart enhanced oxygen transport in the lung understanding and control of growth and changes mechanics of neuromuscular control and robotics prevention of joint degeneration permanent total joint replacements prevention of low back pain workplace designs to enhance productivity ambulation systems for the handicapped fully implantable hearing aids improved understanding of the mechanisms for permanent disability injuries identification of factors such as alcohol use and disease influence on impact tolerance improved cellular bioreactor designs mechanics of DNA and its application in biotechnology. * Obviously, the attainment of these prospects will greatly improve the quality of human life and reduce the costs of living. * This list is from a report by the U. S. National Committee on Biomechanics, April, 1985."

The explosive growth in the field of molecular biology over the last two decades has started to make a great impact on clinical medicine. Genes have been cloned for diseases that were poorly understood only a decade ago. Additionally, investigators are increasingly aware that there are strong genetic components to complex disorders, such as osteoporosis, that are not classically thought of as genetic disorders. New insights into the pathogenesis of metabolic bone diseases have been obtained from investigations into the molecular biology of these diseases and new therapies will become available based on these new insights. In The Genefies of Osteoporosis and Metabolie Bane Disease, I have assembled an internationally renowned group of experts to write the various chapters. Each of the authors is an expert in his/her field who is currently performing research on the content of their chapter and have made important contributions to the understanding of the clinical fea tures and pathophysiology of metabolic bone disease and genetics. The first part of The Genefies of Osteoporosis and Metabolie Bane Disease addresses issues related to genetic contributions to the development of osteoporosis and the many factors that must be considered when searching for genesthat predispose to osteoporosis. The second sec tion addresses recent advances in the clinical and molecular biological aspects of inherited metabolic bone disorders. The last section reviews the latest techniques for finding genes that predispose to metabolic bone diseases.